Abstract
A total of 610 patients with small cell lung cancer were entered into a randomised trial designed to assess the effect of duration of initial chemotherapy on survival. Patients were randomised to receive either four or eight courses of cytotoxic chemotherapy with cyclophosphamide, vincristine and etoposide and also randomised to receive, on disease progression, either second line chemotherapy (methotrexate and doxorubicin) or symptomatic treatment only. In the whole study 196 (32.1%) had limited disease and 414 (67.9%) extensive disease. During initial chemotherapy the response rate (complete and partial responses) after four courses of treatment was 61% with no significant increase in patients receiving eight courses (63%). In those randomised to receive relapse chemotherapy the response rate was improved slightly for those who had originally received four courses of chemotherapy (25.6%) over those receiving eight (18.7%). The overall results show that of the four possible treatment randomizations, four courses of chemotherapy alone is inferior in terms of overall survival (30 weeks median survival) to the other three treatment options (39 weeks median survival, P less than 0.01). In patients responding to initial chemotherapy the disadvantage of four courses of chemotherapy alone was apparent (median survival of 40 weeks versus 49 weeks, P = 0.003) but not if drug treatment was given on relapse. The study shows that limiting treatment to four courses of chemotherapy alone is associated with inferior survival, but this is not the case if chemotherapy is given at relapse.
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- Cullen M., Morgan D., Gregory W., Robinson M., Cox D., McGivern D., Ward M., Richards M., Stableforth D., Macfarlane A. Maintenance chemotherapy for anaplastic small cell carcinoma of the bronchus: a randomised, controlled trial. Cancer Chemother Pharmacol. 1986;17(2):157–160. doi: 10.1007/BF00306746. [DOI] [PubMed] [Google Scholar]
- Evans W. K., Osoba D., Feld R., Shepherd F. A., Bazos M. J., DeBoer G. Etoposide (VP-16) and cisplatin: an effective treatment for relapse in small-cell lung cancer. J Clin Oncol. 1985 Jan;3(1):65–71. doi: 10.1200/JCO.1985.3.1.65. [DOI] [PubMed] [Google Scholar]
- Freedman L. S. Tables of the number of patients required in clinical trials using the logrank test. Stat Med. 1982 Apr-Jun;1(2):121–129. doi: 10.1002/sim.4780010204. [DOI] [PubMed] [Google Scholar]
- Osterlind K., Andersen P. K. Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. Cancer Res. 1986 Aug;46(8):4189–4194. [PubMed] [Google Scholar]
- Souhami R. L., Bradbury I., Geddes D. M., Spiro S. G., Harper P. G., Tobias J. S. Prognostic significance of laboratory parameters measured at diagnosis in small cell carcinoma of the lung. Cancer Res. 1985 Jun;45(6):2878–2882. [PubMed] [Google Scholar]
- Souhami R. L., Geddes D. M., Spiro S. G., Harper P. G., Tobias J. S., Mantell B. S., Fearon F., Bradbury I. Radiotherapy in small cell cancer of the lung treated with combination chemotherapy: a controlled trial. Br Med J (Clin Res Ed) 1984 Jun 2;288(6431):1643–1646. doi: 10.1136/bmj.288.6431.1643. [DOI] [PMC free article] [PubMed] [Google Scholar]